SEP-000594-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-000594-2017 Date Issued: Friday, September 22, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000594-2017
has been completed.
Tax Map Number: 295.14-1-12
Location: 45 AVIATION RD
Owner: David Miele
Applicant: IBS Septic
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, V
Variance,or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
4 1 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000594-2017
Tax Map No: 295.14-1-12
Permission is hereby granted to: IBS Septic
For property located at: 45 AVIATION RD
In the Town of Queensbury,to construct or place at the above location in accordance with application together
with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Tvne of Construction
Owner Name: David Miele Septic Disposal-Residential $0.00
Owner Address: 17 BUTTERNUT HILL DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS Septic
2 WARREN ST
Glens Falls,NY 12801
Plans&Specifications
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,September 20,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queeneueensb
ore the ex ' tion date.)
Dated at the Town of / Jed eptember 20,2017
SIGNED BY: �J for the Town of Queensbury.
Director of Building&Code Enforcement
l`........
SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
742 Bay Road,Queensbury,NY 12804
Ln:n d Qaccn.hun Permit#: SEP'' 2O V/�—
'[
P:518-761-8256 www.gueensbury.net
Tax Map ID#: J• " 1^�Z Permit Fee: $AO ; Invoice#:2_2_
Project Location: I VSe Yes '-' No
Primary Owner(s) Vt
Mailing Address Lf• v 6Aip,�
Phone & Email _
Installer/BuilderTOWN OF QlJ
Mailing Address WO CC -N G& S
Phone & Email �-- – �} r aC C0
Engineer
Mailing Address
Phone & Email
Contact Person for Building&Code Compliance:fLn"A' I Phone:1104
RESIDENCE INFORMATION: /
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes No
1980 or older TAC
nstalled? (circle one)
d�4
1981-1991 Spa or Hot Tub Yes No
Installed? (circle one)
1992-Present
PARCEL INFORMATION: /
Topography Flat Rolling Steep Slope %Slope
Soil Nature J Sand Loam Clay Other
Groundwater At what depth? U IN
Bedrock/Impervious material AtAhat depth?
Domestic Water Supply IMunicipal _Well (if well, water supply from any septic system absorption is_ft.)
Percolation Test Rate: per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size iJ ) gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length ft.; Each Trench ft.
Seepage Pit with#3 stone How many: ; Size:
Alternative System Bed or other type:
Holding Tank System Total required capacity? ;tank size ;#of tanks
NOTES: 1. Alarm system &associated electrical work must be inspected by a Town approved electrical inspection
agency; 2.We will no longer allow systems to be covered until such time as an as-built plan is received and approved.
The installed system must match the septic layout on file—no exceptions.
Declaration:Any permit or approval granted which is based upon or is granted in reliance upon any material
representation or failure to make a material fact or circumstance known by or on behalf of an applicant, shall be void. I
have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance.
PRINT NAME: � DATE:
SIGNATURE: DATE: ` I�
Town of Queensbury Building&Code Enforcement Revised February 2017
I I i
Ir _
111 I _ T PEAK
SEPT!
SE VED All OBJECTS
OR_ E ES, FENG C
ZJ N
SU H A HO SE ' Z,4ENT.t HAVE PERSONALLY —
(D D cD� CD
Cn SD E DIST NCE ET FOR1H ON THIS DIAGRAM.
_ -�
Q C. low DATE
(D
SIGNA E --
Oa) ,
Z3 <_ N �t— l
cf) -
(D O I
I
n ^
m
(D p —
v o
O
o ; I
~
I ! I
C
Q 201
1 TT
OF OUEENSBURY
_BUILDING&CODES_-
vs � �
V-A o
k5
--7 a A
v
a.
RiX'\l0AS BUILT �
5